Health

The Civitas health unit was set up to facilitate informed and impartial debate among key stakeholders, patients, and the grassroots of the medical profession, in order to help build consensus on the future of health care in the UK. Our research aims to bring fresh thinking to problems facing the NHS through careful analysis and a consideration of what can be learnt from other health systems. From this, we endeavour to generate evidence-based ideas that are committed to high-quality, universal, safe and integrated health care.

The NHS is under strain like never before and its woes are rarely out of the headlines for long. Alongside the host of other issues that the service must confront, like a funding blackhole, it also faces severe recruitment problems. Vacancy levels for permanent positions are high, especially in unfavourable specialties such as A&E and in remote parts of the country. This has… [Full Details]

Each day seems to bring fresh warnings of the pressures bearing down on the NHS. As resources fail to keep track of demand, the principle of universal healthcare is under threat as never before. Excessive waiting times, the rationing of new drugs, ambulances queuing up outside A&E, staff shortages, the list goes on. What has brought the NHS to the precarious position it… [Full Details]

Every year, substantial numbers of nurses are recruited from overseas despite nursing courses in the UK being vastly over-subscribed. This has led to a situation where many, well qualified young people in this country are denied the opportunity to become nurses. This yearly limit on nurse education places also puts the NHS in a weak position for hiring and retaining staff as nurses, knowing… [Full Details]

Our country's health system is highly reliant on overseas health workers who often stay less than a year, as well as agency staff who work on a temporary basis at extremely inflated costs. Many posts in unfavourable specialities such as emergency medicine are currently vacant and there is a severe and growing GP recruitment crisis. In this report, Edmund Stubbs suggests that these job… [Full Details]

It is hard to exaggerate the need for increased funding for the NHS. The health service is threatened by a funding gap which could be as large as £30 billion per year by 2020. Even if current yearly efficiency gains were doubled by 2020, it could still be looking at an annual funding gap of £16 billion. Further savings due to efficiency improvement seem optimistic… [Full Details]

Civitas publishes the findings of a year-long study into the effectiveness of the market in the NHS: whether and why it has driven the performance of providers as was intended; and what should be done to make it work better going forwards. Based on in-depth interviews with executives at NHS (foundation) trusts, PCTs, practice-based commissioners and private sector providers across three health… [Full Details]

The NHS has operated on the basis of a market since 2002, with a split between purchasers and providers of health care. In the first comprehensive review of the evidence thus far, the authors show market forces have contributed to: improved access for patients; reduced waiting times and increased efficiency; and improved financial management in providers. However, benefits are not widespread. The NHS appears to… [Full Details]

In recent years, NHS reform in England has focused on stimulating competition between providers and increasing choice for patients. Many NHS organisations are now as much businesses as they are public bodies; if they fail to design services around patients and meet their needs, they should start to lose custom as well as incurring the wrath of government. But just how good are they at… [Full Details]

In its current state, the NHS functions on the basis of what has been variously called a quasi, mimic or internal market, where providers - NHS, voluntary and private - are theoretically competing and placed on an even footing. With debate around this principle intensifying, this paper revisits the anticipated benefits of the use of market mechanisms; asks on what theory they rest; and where the NHS… [Full Details]

As the size and scope of government grows, so do the resources allocated to public services. But how do we know that allocations are fair or reasonable? In "Failing to Figure" Mervyn Stone examines the process, including the allocation of funds to Primary Care Trusts, and finds it lacking in transparency, and even common sense… [Full Details]

The Quality and Outcomes Framework (QOF) links up to a third of general practice income to achievement against a series of quality indicators. While it has delivered benefits in the treatment of conditions included, the net benefit is unclear. There is evidence that the financial incentive is diverting attention away from other conditions and harming the relationship between GPs and patients… [Full Details]

With political interference in the NHS showing no sign of abating, there is a case for considering more radical options than those under review by Lord Darzi: to look to Europe for less centralised ways of providing universal and comprehensive health care. The recent reforms in the Netherlands provide a particularly interesting case… [Full Details]

Described in a foreword by the former President of the Royal College of Surgeons of England, Bernard Ribeiro, as 'an excellent analysis', Seddon argues it is out respect for the very founding principles of the NHS - universal and comprehensive care - that it must embrace its consumers and open up to real choice and competition to turn it once more into a source of pride… [Full Details]